PMT17-03548 City of Menifee Permit No.: PMT17-03548
29714 HAUN RD.
4�k C /_> MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 10105/2017
PERMIT
Site Address: 26234 BRANDYWINE DR, MENIFEE, CA Parcel Number: 335-142-016
92586 Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING LAYERS, INSTALL COOL ROOF SHINGLES --
work: CRRC#0890-0009**
Owner Contractor
KAY MARTIN J D F CONSTRUCTION INC
26234 BRANDYWINE DRIVE 201 GEMINI AVE
MENIFEE, CA 92586 BREA, CA 92821
Applicant Phone:7145261120
NATHAN KELSEY License Number: 956749
J D F CONSTRUCTION INC
201 GEMINI AVE
BREA, CA 92821
Fee Description Qty Amount(SI
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 4.90
$130.90
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emors in the plans and
specifications or from preventing builiding operations being carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 70D0)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. y 1 1 G the following reason:
License as
By my signature below I acknowledge that,except for my personal residence
Expires 1 Signature in which I must have resided far at least one year prior to completion of
WORKER'S COMPENSATION DEClAL1AT10N improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application Is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which w,y,,yy leainfo.ca.¢ov/calaw.html.
this permit is issued.
Policy p Date
rjQltave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier I S (✓a' with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policyp F(o$'O ) Expires enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit is for ne-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which t permit is issued,
I shall not emolov any persons in any anner so as to ome subject to the CITY BUSINESS LICENSE#
workers com nsat n laws of Calif rnia,and a that if I should eco a HAZARDOUS MATERIAL DECLARATION
subject to th worke s compensa n provisions of Sectio4371thebor
Code,I s all rthwit com y wuse visions. Will the applicant or future building occupant handle hazardous material or a
Applicant mixture containing a hazardous material equal to or greater that the
Date amounts specified on the Hazardous Materials Information Guide?
WARNING: AILURE TO SECURE WOR ER'S CO ENSATIS ❑Yes lYNo
UNLAWFUL,AND SHALL SUBJECT AN E PP4OYfR TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes No
I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 10DO feet of the
lending agency for the performance of the work which this permit Is issued outer boundary of a school?
(Section 3097 Civil Code) in Yes I
I-AOWNER BUILDER DECLARATIONS ACalila
\ Hazardous Mated nformation Guid nd the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the list I understan my requireme under the State of
Contractors License Law for the reason(s)indicated below by the t &Safety Cod ,Section 255 and 25534 con rifcheckmark(s)I have placed next to the applicable item(s)(Section 7031.5 rial reportin
Business and Professions Code).Any city or county that requires a permit to Dateconstruct,alter,improve,demolish or repair any structure,prior to its NER OR AUTHORIZED ENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she Is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from Ilcansure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure Is www.epa.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements are not Intended or offered for Certified Firm Name:
sale.If,however,the building or Improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
a
--�C�
DATE: /D I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: ?ADDITION '.%ALTERATION 0 DEMOLITION 0 ELECTRICAL £,MECHANICAL
O NEW PLUMBING 0 RE-ROOF NUMBER OF SQUARES ^� CS\-
DESCRIPTION OF WORK .3J g TCa✓ -OTT 22-906- Cfarn . L`lY\
PROJECT ADDRESS 2(pp23 &OJA I y LcJt yw-, Dr, ZIP 9 S
ASSESSOR'S PARCEL NUMBER 33 • aLo LOT TRACT
OWNER NAME / f larbn
ADDRESS rancly to me, Lr-
PHONE EMAIL
APPLICANT NAME - City of Menifee
ADDRESS IXT
PHONE EMAIL
CONTRACTOR'S NAME b-V\ _0_W_N_E_R_jjQVe hM&O
BUSINESS NAME
ADDRESS Q ( Vl f AYeel , 22 8 a2
PHONE /EMAIL
q
CONTRACTOR'S STATE LIC NUMBER 5-10 _' E- 1 LICENSE CLASSIFICATION rj C?u
VALUATION$ /7 45" � SO FT L SQ FT
APPLICANT'S SIGNATURE DATE 16 /
ITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
D
BUILDING PLANNING ENGINEERING FIRE ACCEPTE BY:
PERMIT FEE �qo SMIP Jw GREEN (�
PLAN CHECK FEE INVOICETOTAL S0. 10
OWNER BUILDERVERIFIED '0 YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER O YES C NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-572-6777
www.Cityofinentfee.US
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